- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $258.67 / $5,621.00 / $9,870.00
| Facility | | $258.67 | $5,621.00 | $9,870.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,285.33 / $5,770.82 / $9,923.85
| Facility | | $2,285.33 | $5,770.82 | $9,923.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,380.56 / $4,380.56 / $5,629.10
| Facility | | $4,380.56 | $4,380.56 | $5,629.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $232.18 / $311.70 / $484.24
| Facility | | $232.18 | $311.70 | $484.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $12,798.00 / $19,665.00
| Facility | | $2,155.00 | $12,798.00 | $19,665.00 |